Download Separate Providers - Fort Myers

Patient Rights Under Florida Transparency Act of 2016
Per Florida law, St. John’s Surgery Center is required to inform you that you may or may not be able to obtain the
recommended medical services at a lesser cost at another facility or in another health care setting. Please know that
your attending physician who prescribed your procedure(s) may not be on the medical staff of such other facilities or
health care setting. St. John’s Surgery Center schedules patient care when your physician schedules a procedure for you
at this surgery center. The facility has one fee that covers the following items: Nursing, technician and related services;
use of the facility; testing for certain lab tests performed at the surgery center such as glucose (blood sugar) and/or
pregnancy; medications administered before, during and after your surgery while in the facility; surgical supplies used by
the physician and staff; equipment used in the facility; surgical dressings if applicable; implants except those specifically
classified as premium implants that require additional patient payment as arranged through the physician’s office.
Separate Providers
Services may be provided in this facility by the facility as well as by other health care providers who may
separately bill the patient. Those separate health care providers may or may not participate with the same health
insurers or health maintenance organizations (HMOs) as this facility. Patients and prospective patients should contact
each health care provider who will provide services in the facility to determine the health insurers and HMOs with
which the provider participates as a network provider or preferred provider.
Another health care provider who will bill you for services includes your physician performing the procedure.
Other providers who will bill separately if they provide you with health care services in this surgery center include an
anesthesia provider who delivers anesthesia services to you at the facility and a pathology provider and laboratory which
will analyze tissue your physician may require be sent to the laboratory to diagnose your condition.
You can contact the facility’s anesthesia providers about whether they participate in your health plan.
Anesthesia Services Plus, Inc.
6241 Arc Way
Fort Myers, FL 33919
Phone: 1-800-437-5179
We may be required to send tissue for analysis by a pathology lab, which may or may not be contracted with your
health plan. You may want to check with your insurer or you can contact the laboratory directly about whether
they participate in your health plan.
Ameripath Southwest Florida
1620 Medical Lane Suite 100
Fort Myers, FL 33907
Phone: (239) 275-1164
Financial Assistance
Per Florida law, St. John’s Surgery Center is required to inform you that financial assistance as well as charity care
is available for patients who meet certain criteria. St. John’s Surgery Center will honor any financial agreements arranged
between the patient and the referring provider. Financial assistance is determined using specific criteria as applicable to
the patient’s financial needs and circumstances.
St. John’s Surgery Center will also honor any agreements relevant to charity care set forth between the patient
and the referring provider. In order for a patient to qualify for consideration, the patient must lack medical insurance and
be a legal resident of Lee, Collier, Charlotte or DeSoto County. Patients must be able to demonstrate financial need and
their best corrected vision must meet certain criteria.
Please direct further inquiries about either policy to your referring provider.